Oncologic outcomes of laparoscopic radical nephroureterectomy in conjunction with template-based lymph node dissection: An extended follow-up study

Matsumoto, Ryuji; Abe, Takashige; Takada, Norikata; Minami, Keita; Harabayashi, Toru; Nagamori, Satoshi; Hatanaka, Kanako C.; Yamashiro, Katsushige; Kojima, Hiroshi; Osawa, Takahiro; Maruyama, Satoru; Shinohara, Nobuo

doi:10.1016/j.urolonc.2020.05.013

Cited by 9 publications

(13 citation statements)

References 19 publications

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“…Abe et al has reported the treatment outcome of lymphadenectomy for UTUC. 22,23 Moreover, similar to the current report, laparoscopic RPLND could be safely performed and was equivalent to open surgery. The first feature of the current study is the retroperitoneal approach.…”

Section: Discussionsupporting

confidence: 86%

Complications and their management following retroperitoneal lymph node dissection in conjunction with retroperitoneal laparoscopic radical nephroureterectomy

et al. 2022

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Objectives To describe the detailed perioperative complications and their management after retroperitoneal lymph node dissection with retroperitoneal laparoscopic radical nephroureterectomy for patients with upper tract urothelial carcinoma at three institutions. Methods Retroperitoneal lymph node dissection was performed on patients with upper tract urothelial carcinoma located at the pelvis and/or upper or middle ureter, and its template included the renal hilar and para‐aortic lymph nodes (left side) and the renal hilar, paracaval, retrocaval, and intra‐aortocaval lymph nodes (right side). The lymph nodes and kidneys were removed en bloc. The primary endpoint was postoperative complication rates, and the secondary endpoints were intraoperative findings and chylous leakage management. The associations of retroperitoneal lymph node dissection with postoperative complications were examined using logistic regression with propensity score techniques. Results Eighty‐eight (31%) and 195 (69%) patients underwent and did not undergo retroperitoneal lymph node dissection, respectively. There was no significant difference in postoperative complications and other perioperative findings in the entire cohort, except for prolonged operation time. Retroperitoneal lymph node dissection was not statistically significantly associated with total and serious complications in propensity score analyses. Postoperative chylous leakage could be conservatively managed even though it is common in patients with retroperitoneal lymph node dissection (14/88 (16%)). The incidence of chylous leakage was significantly lower in patients whose lymphatic vessels were meticulously clipped completely during retroperitoneal lymph node dissection (5.3% vs 24%; P = 0.017). Conclusion There was no association between retroperitoneal lymph node dissection with laparoscopic radical nephroureterectomy and postoperative complications. However, chylous leakage is often observed after retroperitoneal lymph node dissection and careful management is highly required. The use of clips during retroperitoneal lymph node dissection is recommended to minimize chylous leakage risk.

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Section: Discussionsupporting

confidence: 86%

Complications and their management following retroperitoneal lymph node dissection in conjunction with retroperitoneal laparoscopic radical nephroureterectomy

et al. 2022

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“…To date, a number of studies have reported the importance of recognizing systemic regional LND based on anatomical templates as an indispensable adjunct to RNU for UTUC patients for both staging and therapeutic purposes. [2][3][4][5][6][7] In a systematic review by Dominguez-Escirg et al, 2 templatebased and complete LND were clearly shown to increase CSS and reduce the risk of local recurrence in patients with high-stage UTUC. However, the outcomes of UTUC patients undergoing systemic regional LND in addition to RNU remain unsatisfactory.…”

Section: Discussionmentioning

confidence: 99%

“…However, the outcomes of UTUC patients undergoing systemic regional LND in addition to RNU remain unsatisfactory. [2][3][4][5][6][7] For example, Kondo et al 4 reported that 13% and 23% of patients with renal pelvic and ureteral cancers, respectively, developed disease recurrence after template-based LND. These findings indicate the importance of identifying factors associated with the outcomes of UTUC patients who underwent systemic regional LND in order to consider additional intensive treatments for this cohort of patients.…”

Section: Discussionmentioning

confidence: 99%

“…7 However, the outcomes of UTUC patients even after RNU and systematic regional LND have not been completely satisfactory. [2][3][4][5][6][7] Therefore, we retrospectively analyzed the clinical outcomes of 68 consecutive UTUC patients who underwent RNU and systematic regional LND based on anatomical templates according to the main tumor location in order to identify prognostic factors in this cohort of patients.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic assessments in patients with upper tract urothelial carcinoma undergoing radical nephroureterectomy and systematic regional lymph node dissection

et al. 2021

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Objectives: Systematic regional lymph node dissection (LND) combined with radical nephroureterectomy (RNU) has been reported to improve the outcomes of upper tract urothelial carcinoma (UTUC) patients. The objective of the present study was to assess the prognostic outcomes of UTUC patients undergoing systematic regional LND combined with RNU. Patients and methods: We conducted a retrospective evaluation of prognostic outcomes of 68 consecutive UTUC patients treated with RUN and systematic regional LND. Results: The median durations of recurrence-free survival (RFS) and overall survival (OS) were 45 and 166 months, respectively. Univariate analyses of several parameters showed that despite the lack of a significant predictor for RFS, the presence of lymph node metastasis correlated with poor OS. Conclusion: These results suggest that comparatively favorable outcomes are achievable in UTUC patients by RNU and systematic regional LND; however, special attention is needed for patients with nodal involvement even after systematic regional LND due to the adverse impact of this factor on OS.

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“…Nevertheless, these findings must be tempered by the retrospective design and the low number of tumors studied at each location. Prospective studies are evaluating the appropriate template of LND in cN0 patients on oncologic outcomes and safety ( 40 , 41 ). Long terms results and controlled trials are needed to answer the question.…”

Section: Methodsmentioning

confidence: 99%

Lymph Node Dissection During Radical Nephro-Ureterectomy for Upper Tract Urothelial Carcinoma: A Review

et al. 2022

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Although lymphonodal dissection is well-accepted for muscle-invasive bladder cancer management, its role is still debated during radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). The aim of this study was to summarize the current knowledge concerning the indication, anatomical template, prognostic, and therapeutic roles of lymph node dissection (LND) performed at the time of RNU. Quality control markers, such as the number of lymph nodes (LN) removed, lymph node density, and safety of the different surgical approaches, were assessed. We performed a narrative review using the PubMed and ClinicalTrials.gov databases. We identified and analyzed articles based on the practice and the role of lymph node dissection for non-metastatic UTUC. There are no clear guidelines regarding the indication of LND for UTUC, but aggressive tumors may beneficiate from lymphadenectomy since lymph node invasion is a clear independent poor prognostic factor, allowing for adjuvant treatments. It seems that an extended lymphadenectomy may provide therapeutic advantages as a higher number of nodes removed may be related to the removal of undetected LNs micrometastases and a subsequent improvement in recurrence rate and cancer-specific survival. Clear anatomical templates are thus needed based on the location and the laterality of the primary tumor.

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Oncologic outcomes of laparoscopic radical nephroureterectomy in conjunction with template-based lymph node dissection: An extended follow-up study

Cited by 9 publications

References 19 publications

Complications and their management following retroperitoneal lymph node dissection in conjunction with retroperitoneal laparoscopic radical nephroureterectomy

Complications and their management following retroperitoneal lymph node dissection in conjunction with retroperitoneal laparoscopic radical nephroureterectomy

Prognostic assessments in patients with upper tract urothelial carcinoma undergoing radical nephroureterectomy and systematic regional lymph node dissection

Lymph Node Dissection During Radical Nephro-Ureterectomy for Upper Tract Urothelial Carcinoma: A Review

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